Safe and sound

on 4 May 2006

It is only natural that dentists want to make their practices as safe as possible. Accidents happen relatively rarely but there is always scope for improvement.

First there are the basics, so make sure the practice has:

• Practising certificates for the dentists and hygienists

• Professional indemnity insurance for all practitioners

• Practice insurance, including public liability

• Employer’s liability insurance certificate – which must be displayed

• Data protection registration

• TV licence, if necessary

• Health and Safety poster

• Performing rights licence for playing music.

In addition there should be arrangements for clinical waste collection and disposal, a radiation survey/safety log, a maintenance programme of inspection and certificate for the autoclave and compressor, and a COSHH assessment of substances hazardous to health. The practice should also have a first-aid kit and an accident book.

Don’t forget about the staff either. These days it is very risky not to have proper documentation in case of any dispute with them, so make you have:

• Job descriptions, including written terms of employment, payment arrangements, holiday and sickness arrangements, pension, duration of employment, notice period and grievance and disciplinary arrangements.

• Job descriptions or associate agreements for each associate.

• Contracts for each associate and hygienist.

Then there are some other bits and pieces – arrangements for regular staff meetings, protective clothing for staff as required and arrangements for recording staff sickness and collecting medical certificates.

Education is at the heart of setting standards and clinical governance. All dentists must now ensure they have a suitable programme of continuing professional development as well as an education programme for their staff. Making sure it is right will be reviewed in a later article.

Having arranged all the necessary documents, insurance and organisational arrangements it is then time to take a look at the building itself. Dentists, as far as is reasonably practicable, must ensure that any place of work under his or her control is maintained in a safe condition, without risks to health. There are some simple things that can be checked here to eliminate hazards.

For example, are there any large glass doors which might not be seen by partially sighted patients? If so, add adhesive, coloured circles that make them more visible. Do any of them open in such a way that someone coming the other way could be injured? Perhaps glass panels in them will make them safer.

Are fire doors and fire escapes appropriately made and signposted? Ensure they are kept secure but allow easy egress in the event of a fire or other emergency. Check the reception area. The desk should be secure and designed so that patients cannot read information about other patients. Part of the counter should be designed to meet the needs of disabled patients, where appropriate.

There should be security arrangements in place for staff to protect them from unruly attendees. A hearing loop for the deaf is also important. And it is essential to ensure that patient details are kept securely, in keeping with the requirements of the Data Protection Act.

Check the arrangements for accepting money. These days there might be quite a lot of money in the practice. It needs to be held securely.

Check out the water arrangements. It is important that water can be heated for tea, but make sure there is no risk of accident with the kettle. It is worth putting an adhesive sign over the hot water tap pointing out that the water is hot! As for the water supplies in the surgery, there can’t be a dentist in the country who doesn’t know about the Water Supply Regulations.

Ensure there are secure lockable cupboards for any toxic or corrosive fluids. Make sure clinical waste sacks are kept away from prying hands, especially when awaiting collection. Toilets should be accessible for the disabled. Doors should open outwards and be wide enough for a wheelchair. It should be possible to open toilet doors from the outside using an appropriate tool to enable entry in the event of a medical emergency.

Then there is the mass of other legislation governing duties to staff, first aid, fire safety, electricity, substances hazardous to health, waste collection, pressure systems, computers, manual handling, reporting injuries and cross-infection – and of course radiation. Disabled legislation is important too.

Does it matter if you don’t meet all these standards? Well, yes. Health and Safety legislation is strict and Health and Safety inspectors have considerable power. They can inspect dental practices and have a right of entry. They may telephone to make an appointment but can turn up unannounced.

Inspectors can interview anyone and look at anything. Increasingly, they are looking for evidence of good practice management such as safe electrical equipment, normal toilet and washing standards, adequate heating and water arrangements and proper waste collection.

After such an inspection the inspector would normally approach the person in administrative charge, often the practice manager. He would normally simply ask for minor faulty procedures or equipment to be put right, but in more serious situations he can issue an improvement notice requiring improvements to be made within a set time. If there is a very serious problem the inspector can order a prohibition notice, which could result in the practice stopping work immediately.